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General NPI Number Information
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NPI Number | 1801963558
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Entity Type | Organization
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Legal Business Name | LINCOLNWAY DENTAL CENTER, PC
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Dates
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Enumeration Date | 11/29/2006
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Last Update Date | 04/23/2008
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Provider Practice Location Address
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Address Line | 417 S LINCOLNWAY SUITE A
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City | NORTH AURORA
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State | IL
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Zip | 60542-5109
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Country | US
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Telephone | 630-897-1300
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Fax | 630-897-7172
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Provider Business Mailing Address
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Address Line | 417 S LINCOLNWAY SUITE A
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City | NORTH AURORA
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State | IL
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Zip | 60542-5109
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Country | US
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Telephone | 630-897-1300
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Fax | 630-897-7172
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. DEAN MOON PARK
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Credential | D.M.D.
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Telephone | 630-897-1300
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 019022694
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 019024704
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License Number State | IL
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Taxonomy #3
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 019020375
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License Number State | IL
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